1790230589 NPI number — LOIS PULVERMACHER AND ASSOCIATES LLC

Table of content: (NPI 1790230589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790230589 NPI number — LOIS PULVERMACHER AND ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOIS PULVERMACHER AND ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790230589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 PRIMROSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54311-6882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-712-4526
Provider Business Mailing Address Fax Number:
800-469-0235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 CHALLENGER DR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54311-8351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-712-4526
Provider Business Practice Location Address Fax Number:
800-469-0235
Provider Enumeration Date:
08/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PULVERMACHER
Authorized Official First Name:
LOIS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
920-712-4526

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW 7302-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40918400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com